AB0221 A STUDY OF REVERSIBILITY OF FRAILTY IN RHEUMATOID ARTHRITIS FROM THE T-FLAG STUDY
Authors: M. Suzuki, Y. Sobue, Y. Ohashi, R. Sato, D. Kihira, M. Maeda, K. Kishimoto, K. Terabe, S. Asai, S. Imagama
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that causes joint symptoms due to inflammation in bones and joints, leading to physical dysfunction such as loss of activities of daily living. With advances in the treatment of RA, it has become possible to achieve the goal of treatment to a state in which joint destruction causes little deformity and no physical disability. However, RA is a disease that causes not only physical dysfunction but also generalized fatigue due to chronic inflammation. Therefore, there is a decrease in patient satisfaction due to pain and physical fatigue, which may lead to a decline in daily life. Frailty, a state of physical and mental frailty due to decreased physical and mental function and social connectedness, is a condition that can easily lead to functional disability in daily living and the outcome of requiring long-term care [1]. RA is known to cause pain and limited range of motion of joints as the disease activity worsens, which may contribute to frailty. Since frailty is reversible and patients can return to a healthy state with appropriate interventions [2], it is expected that appropriate interventions will help maintain and improve the functions of daily living. <h3>Objectives</h3> The purpose of this study was to investigate factors associated with improvement from frailty in RA patients. <h3>Methods</h3> Of 460 RA patients (a observational study, T-FLAG study) who completed a questionnaire on frailty including the Kihon Checklist (KCL) from June 2020 to August 2022, 321 patients who were Frailty/Pre-frailty at baseline were included. After 2 years, patients who had improved from frailty to pre-frailty/robust or pre-frailty to robust were included in the improvement group, and the other patients were included in the non-improvement group. Multivariate analysis was used to examine the factors associated with improvement at 2 years. The cutoff values of the factors related to improvement were calculated by ROC analysis. <h3>Results</h3> Mean age (± standard deviation) was 67±13 years at baseline, 76% were female, duration of disease was 12±10 years, and BMI was 22.1±4.0. There were 83 patients (25.9%) in the improvement group. There were significant differences in age at baseline (63 vs. 68 years), DAS28-ESR (2.57 vs. 3.06), HAQ-DI (0.19 vs. 0.65), and KCL score (7.0 vs. 8.7) in the improvement group vs. the non-improvement group. There was no significant difference in gender (76% vs. 77%), disease duration (10 vs. 12 years) and BMI (21.8 vs. 22.3 years). Multivariate analysis revealed that age (OR: 0.97, 95% CI: 0.95-0.99) and HAQ-DI (OR: 0.19, 95% CI: 0.08-0.42) were independent factors associated with improvement (Table 1). The age and HAQ-DI cutoff values related to improvement were 72 years (sensitivity 73.5%, specificity 44.1%) and 0.25 points (sensitivity 78.3%, specificity 58.9%). The cutoff value of HAQ-DI was used to examine the rate of improvement group in the two groups. In the HAQ-DI≤0.25 group, 40.1% of patients were in the improvement group, while only 11.5% were in the improvement group in the HAQ-DI&gt;0.25 group, indicating a significant difference between the two groups (P&lt;0.001). <h3>Conclusion</h3> Age and HAQ-DI were found to be indices for improvement in RA patients. Since frailty is a state in which physical and mental vitality declines with age, it is important to know age, which is a reversible state of frailty. In addition, among the multifactorial components of frailty, a low HAQ-DI, an assessment of physical function, may indicate the possibility of improving from a frailty state with appropriate intervention. <h3>References</h3> [1] Salaffi F, et al. Prevalence of frailty and its associated factors in patients with rheumatoid arthritis: a cross-sectional analysis. Clin Rheumatol. 2019;38(7):1823-30. [2] Kuzuya M. Process of physical disability among older adults--contribution of frailty in the super-aged society. Nagoya J Med Sci. 2012;74(1-2):31-7. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.